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Birth Control Bingo: Withdrawal

Withdrawal is one of the oldest methods of birth control there is. In the Book of Genesis in the Bible, withdrawal ("pulling out") is described as a method of contraception used by Onan when he ejaculates on the ground in the hopes he won't get his dead brother's wife pregnant after having sex with her. Umm...classy. Withdrawal and other similar methods like "coitus obstructus" can also be found, however, in early Sanskrit texts without such creeptastic context.

The most recent National Survey of Family Growth found around 60 percent of sexually active women have used withdrawal at some point in their lives. That bit and other discussion about current use of withdrawal can be found here.

Withdrawal is:

96% effective in one year of perfect use (estimated); 4 out of every 100 people will become pregnant

73-82% effective in one year of typical use: 18-27 out of every 100 people will become pregnant

What's typical or perfect use mean? Effectiveness rates of contraceptive methods are all figured based on one full year of use, not for each single incident of sex or use of a method. Perfect, or proper, use of a method means that in one year, that method was always used, and always used following the directions for that method to the letter. Perfect use of most methods in one full year is unusual, except for methods like the IUD or implant where a user does not have to do anything. Typical use means that in one year, sometimes a method has not been used according to the directions, or was not always used. Typical use is called that because that is most typically how methods are used in a full year, since people aren't perfect.

The What, the Why, the Where, the When, and the How-to: Withdrawal is sometimes called "pulling out" or coitus interruptus, latin for interrupted intercourse: it's when, during intercourse and well before ejaculation, a partner withdraws their penis from the vagina and ejaculates elsewhere -- and not anywhere near their partner's genitals. For those who like to geek, coitus reservatus is the latin term for someone trying to reserve ejaculation entirely or who withdraws from intercourse without ejaculating at all.

The pros are that it's free and it doesn't have any side effects. It can safely be combined with any other method of contraception. The cons are that many couples find it frustrating to have to cease sex to use it solely, and especially before orgasm, that it is a method which the person who may themselves become pregnant if it fails has no control over, and that it does fail often in typical use. For younger people, it can be particularly hard to use without mucking it up, since proper use requires having a good deal of knowledge and control from experience, experience younger people just don't usually have much of.

What will/might you need to discuss or negotiate with a partner?

How it needs to be used properly, namely that they -- or you -- need to withdraw either without ejaculating or well before (not just seconds before, or at the time of) ejaculation

Where they -- or you -- want or intend to ejaculate, and what each of you is or isn't okay with per where you (or your partner) ejaculates; if semen is something you (or they) do or don't want cleaned up right away or not

Possible semen allergies or sensitivities (it is currently estimated as many as around 10% of people may have them)

STI status and history, if withdrawal is not being combined with condom use

When Good Birth Control Does Bad Things: When withdrawal fails, it is most often because a partner does not withdraw at all, does not withdraw in time (not seconds or moments before), well before ejaculation, or because even if they do withdraw, they still ejaculate on a partner's genitals. Much more rarely, pre-ejaculatemay sometimes contain sperm cells picked up in the urethra from a previous ejaculation, and those sperm cells may be able to co-create a pregnancy.

To be clear: pre-ejaculate does not ever, all by itself, contain sperm. What can happen, though, is that on the way out of the penis, it can pick up sperm left over from a previous ejaculation. However, pre-ejaculate is understood to be highly unlikely to contain sperm if someone has urinated since their last ejaculation, and while few studies have been done on this, those which have have support that premise.

Withdrawal appears to be less effective for young adults than it is for older adults, likely due to both high fertility rates of younger people and, again, lack of experience with and control of the body. There are many studies on teen pregnancy which find withdrawal is a common method in those pregnancies, and that pregnancy among teens has been declining in large part due to increased use of far more effective methods of birth control, or in pairing withdrawal with other, more effective methods.

Think or know you used this method improperly, or know that you have had a pregnancy risk due to unprotected sex? It might not be too late for you to prevent an unwanted pregnancy with a method of emergency contraception.

Younger people do tend to be more impulsive (the nice word for that is spontaneous, and it is a cool thing about y'all when it's not endangering you or others) than their older counterparts, and for plenty of young couples using withdrawal, it seems it sometimes doesn't take long to get to a time when a partner decides to go without withdrawing on purpose -- often without consulting their partner -- or wait until what seems like the very last minute -- and turns out to be too late -- "just this once." Anyone practicing withdrawal has got to have a lot of self-control, something that can tend to be difficult for people of any age at the same moment they're having a big orgasm.

Of course, no single method of contraception is 100% effective, even in perfect use. And it's sage to remember that there are situations -- be they financial or situational -- where for some couples it's only less effective (than most other) methods like withdrawal or spermicides which are available, or when the only method a partner can be talked into at a time is withdrawal. Withdrawal IS a method of contraception like all others: it's just one of the least effective compared to other methods. In general, it is usually best used as a backup method for another method, as it is one of the least effective of all available methods, even in perfect use.

Why would withdrawal be a good option for me? If any of the following are true:

You or your partner are currently unable to access any other method of birth control, and are unwilling to abstain from intercourse

You are combining it with another method

Your partner (or you, if you're the person who will be withdrawing) is considerably experienced in both knowing their own sexual responses with a partner and at timing withdrawal, and takes the risk of pregnancy very seriously

You and a partner communicate very well about sex, and your partner is very invested in preventing a pregnancy

You are not bothered by, or prefer, a lack of ejaculation into the vagina

You are looking for a method you only have to think about at the time you're going to have sex

You are currently breastfeeding and cannot use many hormonal methods

You and your partner are monogamous and have both recently been tested for STIs and been found to be negative for all of them

Don't forget: Statistically, sexually active young adults are as, if not more, likely to acquire a sexually transmitted infection (STI) as you are to become pregnant. Although 15-24-year-olds represent only one-quarter of the sexually active population, they account for nearly half of all new STIs each year, and of the 18.9 million new cases of STIs each year, 9.1 million (48%) occur among 15-24-year-olds (AGI). Often people have some funny ideas about who is most likely to get an STI, but the fact of the matter is that younger people -- of any sexual orientation, any economic class, any kind of relationship -- have been the highest risk group for some time now.

Condoms are the only method of birth control which also provide protection against STIs. It's pretty typical for younger people to ditch condoms if they have another method of birth control, so just remember that STIs are still a risk if you're using another method. You can read all about safer sex here -- Safe, Sound & Sexy: A Safer Sex How-To -- but the rule of thumb most medical experts and prevention organizations suggest, which we also encourage at Scarleteen is six months of safer sex, six months of sexual monogamy, and then TWO full STI screenings for each partner -- once at the start of that six months, once at the end -- before ditching latex barriers.

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Information on this site is provided for educational purposes. It is not meant to and cannot substitute for advice or care provided by an in-person medical professional. The information contained herein is not meant to be used to diagnose or treat a health problem or disease, or for prescribing any medication. You should always consult your own healthcare provider if you have a health problem or medical condition.